Paediatric upper urinary tract calculi can be treated by Ureteroscopy (URS) or Mini-percutaneous nephrolithotomy (mPCNL). We wanted to compare outcomes of URS and mPCNL from two tertiary referral centres who specialised in one of these treatments for paediatric stone disease.
Data was collected from two tertiary centres over a 10-year period (2010-2019); one centre specialising in URS and the other in mPCNL for consecutive patients ≤16 years of age undergoing either of these minimally invasive interventions. Upper urinary tract stones included stones in the kidney, PUJ and proximal ureter while mid or distal ureteric stones were excluded. Data was collected on patient and stone demographics. Outcomes of interest included stone free rate (SFR) and complication rates.
During the study period, 55 patients underwent URS (group 1) and 40 patients underwent mPCNL (group 2). The mean stone size for groups 1 and 2 were 11.4mm and 14.5 mm respectively, whereas twice as many patients in group 1 had multiple stones. The final SFR and complication rates for groups 1 and 2 were 100% and 97.5%; and 5.4% and 12.5% respectively. While there were two Clavien II and one Clavien IV complication in the URS group, all five complications in mPCNL group were Clavien I.
Our study shows excellent outcomes for upper urinary tract stones with both URS and mPCNL. While treatment choices should be tailored to patients, each modality carries different advantages and our results reflect that high-volume centres specialising in a particular technique offer best outcomes and this must also be borne in mind when counselling patients.
Journal of endourology. 2020 Apr 22 [Epub ahead of print]
Patrick Jones, Dilip Kumar Mishra, Madhu S Agrawal, Stephen Griffin, Bhaskar K Somani
University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland; ., Global Rainbow Healthcare, Urology, AGRA, Uttar Pradesh, India; ., s n medical college, urology div, dept of surgery, hospital road, agra, agra, UP, India, 282002., University Hospitals Southampton NHS Trust, Paediatric Urology, Southampton, United Kingdom of Great Britain and Northern Ireland; ., University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland.